Cochrane Database Syst Rev. 2012 Apr 18;4:CD004309.
Abstract
BACKGROUND:
Etoricoxib
is a selective cyclo-oxygenase-2 (COX-2) inhibitor licensed for the
relief of chronic pain in osteoarthritis and rheumatoid arthritis, and
acute pain in some jurisdictions. This class of drugs is believed to be
associated with fewer upper gastrointestinal adverse effects than
conventional non-steroidal anti-inflammatory drugs (NSAIDs). One
additional study in acute postoperative pain has been published since
the original review was completed in Issue 2, 2009.
OBJECTIVES:
To
assess the analgesic efficacy and adverse effects of a single oral dose
of etoricoxib for moderate to severe postoperative pain.
SEARCH METHODS:
We
searched the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, the Oxford Pain Database, ClinicalTrials.gov, and
reference lists of articles. The date of the most recent search was 3
January 2012.
SELECTION CRITERIA:
Randomised,
double-blind, placebo-controlled clinical trials of single dose, oral
etoricoxib for acute postoperative pain in adults.
DATA COLLECTION AND ANALYSIS:
Two
review authors independently considered trials for inclusion in the
review, assessed quality, and extracted data. We used the area under the
pain relief versus time curve to derive the proportion of participants
prescribed etoricoxib or placebo with at least 50% pain relief over six
hours, using validated equations. We calculated relative risk (RR) and
number needed to treat to benefit (NNT). We used information on use of
rescue medication to calculate the proportion of participants requiring
rescue medication and the weighted mean of the median time to use. We
also collected information on adverse effects.
MAIN RESULTS:
One
additional study has been added to this updated review, making a total
of six included studies with 1214 participants in comparisons of
etoricoxib with placebo. All six studies reported on the 120 mg dose
(798 participants in a comparison with placebo). At least 50% pain
relief was reported by 66% with etoricoxib 120 mg and 12% with placebo
(NNT 1.8 (1.7 to 2.0)). For dental studies only the NNT was 1.6 (1.5 to
1.8). Although the new study almost doubled the number of participants
in included studies it added only about 25% more data for the 120 mg
dose and the result was unchanged. Other doses (60, 90, 180, and 240 mg)
were each studied in only one treatment arm and we did not undertake
pooled analysis.Significantly fewer participants used rescue medication
over 24 hours when taking etoricoxib 120 mg than placebo (NNT to prevent
remedication 2.2 (1.9 to 2.8)), and the median time to use of rescue
medication was 20 hours for etoricoxib and two hours for placebo.
Adverse events were reported at a similar rate to placebo, with no
serious events.
AUTHORS' CONCLUSIONS:
The additional
study did not change the results from the first review published in
2009, but does make the result more robust. Single dose oral etoricoxib
produces high levels of good quality pain relief after surgery and
adverse events did not differ from placebo. The 120 mg dose is as
effective as, or better than, other commonly used analgesics.
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